Chinese Foot Binding: Radiographic Findings and Case Report.

A 99-year-old Chinese woman presented to our emergency department after a fall. Due to lower extremity pain, radiographs of both feet were obtained. No fractures were noted, but these images did reveal prominent pes cavus deformities and foreshortening of the feet, consistent with foot binding as a child. The radiographic findings associated with foot binding are described and other associated health consequences are discussed.

Case Report

A 99-year-old Chinese woman (born in 1906) presented to the emergency department after a fall. She stated that she fell due to not placing her walker onto the floor correctly. She denied lightheadedness, dizziness, palpitations or blurry vision prior to the fall. Other pertinent medical history included history of occasional paroxysmal atrial fibrillation.

Radiographs of both feet were obtained due to lower extremity pain (Fig. 1). No fractures were noted, but these images did reveal prominent bilateral pes cavus deformities, vertical orientation of the calcanei, and foreshortening of both feet, consistent with foot binding as a child.

Figure 1

99-year-old Chinese woman who had bound feet as a child. AP radiographs of the left (A) and right (B) feet, showing diffuse osteopenia and medial dislocation of both fifth toes. Prominent subchondral cyst formation is noted at the right first metatarsophalangeal joint, most likely due to osteoarthritis. Lateral radiographs of the left (C) and right (D) feet, demonstrating a marked pes cavus deformity bilaterally, vertical orientation of the calcanei, and foreshortening of both feet consistent with foot binding.

Discussion

Foot binding began in the Sung dynasty (CE 960–1280) in China. Young girls‘ feet were tightly bound with bandages, resulting in marked foreshortening of the feet. Although foot binding was first practiced by the elite, it had spread among all social classes by the time of the late Qing dynasty (CE 1644–1912) (1, 2, 3).

Foot binding was first outlawed in China in 1912 following the Taiping Rebellion, and again after the Communist takeover in 1949. Despite these bans, the practice continued in various parts of the country. A 1997 study of Chinese women in Beijing showed a prevalence of foot binding of 18% in women 70 – 79 years of age and 38% in those 80 years and older (1).

The radiographic findings noted in our patient are quite similar to those reported by other investigators (4, 5, 6, 7, 8, 9), and include marked pes cavus, vertical orientation of the calcanei, and foreshortening of the feet.

Besides the foot deformities, there are other health consequences associated with foot binding. Cummins et al found that women with bound feet were more likely to fall than those with normal feet (1). This increased risk of falling was 2.0 more likely in women 80 or older and 1.47 times more likely in 70 – 79 year olds. Women with bound feet were also less able to squat, and less able to stand up from a chair without assistance than women with normal feet . They also had 14.3% less functional reach (a test of balance) and 5.1% lower hip bone density (1). It is intriguing to speculate whether the modern Western form of foot binding (high heel shoes) may also be associated with similar consequences (10).

The incidence of falling in the elderly Chinese population is almost 50% higher in women than men (11). While many factors have been implicated as risk factors for falling, foot binding may partially explain this increased risk for women over men. The patient we describe had been admitted once before for falling, and both of her falls may be partially related to her foot deformities. However, her episodic cardiac arrhythmia may have also played a role in her falls.

Although foot binding has not been practiced for many years, a significant number of elderly Chinese women continue to exhibit this acquired deformity. The combination of increased likelihood of falling and lower hip bone density is likely to increase the risk of hip fractures in this population. Physicians practicing in areas with large Chinese populations should be aware of foot binding and its risks.